112 The Professional Counselor | Volume 12, Issue 2 Despite the fact that these products are readily available over the counter, drugs like diphenhydramine as well as doxylamine are not designed for the long-term treatment of sleep disorders (Abraham et al., 2017). There is a lack of supporting literature in terms of using these drugs for treatment of mental health concerns (Culpepper &Wingertzahn, 2015). It is important to note that if clients are prescribed an antidepressant, chlorpheniramine as well as diphenhydramine can increase the risk of serotonin syndrome (Abraham et al., 2017). It is also important to keep in mind that diphenhydramine can be found in combination with pain relievers/fever reducers such as acetaminophen. This may add to the risk of developing serotonin syndrome because clients may not be aware of the exact content of these formulations (Abraham et al., 2017). Diphenhydramine may also be a drug of abuse. When taken in high doses, it may create a buzz or high because of possible activation of the dopamine-related reward pathways of the brain, which may lead to drug-seeking behaviors (Saran et al., 2017). Finally, a lethal dose of doxylamine can range from 25mg–250mg per kg in body weight (Müller, 1992, as cited in Bockholdt et al., 2001). Doxylamine overdose symptoms include respiratory depression, sedation, and coma (Bockholdt et al., 2001). Dietary Supplements Dietary supplements are defined as dietary ingredients that include vitamins, minerals, amino acids, and herbs or botanicals, as well as other substances that can be used to supplement the diet (FDA, 2015). Much like herbal remedies, the FDA does not sufficiently regulate dietary supplements. Melatonin Melatonin is a naturally occurring substance that is synthesized from tryptophan. It is secreted by the pineal gland in order to regulate the circadian rhythm. Melatonin is effective in inducing sleep when taken orally as well. In the United States, synthesized melatonin is marketed as a dietary supplement and can be purchased over the counter in doses ranging from 0.3mg–10mg (Perry et al., 2006). Because the FDA does not sufficiently regulate melatonin, it is important to note that specific dosing guidelines do not exist (R. A. Savage et al., 2020). However, studies have found that doses over 5mg are no more effective than lower doses. Side effects may include headache, fatigue, dizziness, irritability, abdominal cramps, itchiness, and elevated alkaline phosphatase in long-term use (Perry et al., 2006). Furthermore, it was found that the labeled concentration of melatonin content frequently does not match actual content. Erland and Saxena (2017) found variability of melatonin in various samples ranging between 83% (lesser dose) to +478% (higher dose). Erland and Saxena also found that eight of their 30 samples contained undisclosed/unlabeled serotonin in addition to melatonin, which may add to health concerns. The majority of supplements that were found to include serotonin also contained other additives such as passionflower, hops, and valerian root. Interestingly, serotonin is a precursor to melatonin (Erland & Saxena, 2017). Unlabeled serotonin content poses a significant problem because many clients self-prescribe melatonin supplements and, under the right circumstances, a relatively small dose can lead to serotonin syndrome (Erland & Saxena, 2017). SAMe SAMe (S-Adenosyl-L-methionine) is required for the brain to synthesize the neurotransmitters norepinephrine, dopamine, and serotonin. In the United States, SAMe has been widely available over the counter since the late 1990s (Mischoulon & Fava, 2002). The general consensus is that it is effective in treating depression (Sakurai et al., 2020). Also, SAMe can be utilized as an adjunct to antidepressant medications (Papakostas, 2009; Sakurai et al., 2020). It can be taken orally or be administered by intravenous infusion (Sakurai et al. 2020). A recommended dose of SAMe can range
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